1/73. Ventricular pacing failure after a single oral dose of pilsicainide in a patient with a permanent pacemaker and paroxysmal atrial fibrillation.A single oral dose of pilsicainide, a Class Ic antiarrhythmic drug, is a widely used and highly effective therapy for termination of recent onset atrial fibrillation. We report on a patient in which ventricular pacing failure occurred immediately after a single oral dose of pilsicainide. It did not exhibit a parallel relationship between the change in the pacing threshold and plasma concentration of pilsicainide, and the recovery period for the ventricular pacing threshold was longer than that of the plasma concentration of pilsicainide in this patient. Careful attention should be paid when a single oral dose of pilsicainide for termination of recent onset atrial fibrillation is used in patients with permanent pacemakers.- - - - - - - - - - ranking = 1keywords = rhythm (Clic here for more details about this article) |
2/73. sick sinus syndrome in a patient with single coronary artery anomaly.Single coronary artery anomaly is very rare. The reported manifestations include angina pectoris and congestive heart failure. Here we describe a case of single coronary artery anomaly presenting as sick sinus syndrome, which has no literature precedence. A 47-year-old woman had complained of intermittent dizziness for years. A Holter electrocardiogram showed sinus bradycardia and junctional or ventricular rhythm with a maximal ventricular pause of up to 3.2 seconds. Electrophysiologic study revealed prolonged corrected sinus nodal recovery time. coronary angiography showed that the left anterior descending artery had a long course with a side branch originating from the proximal part and coursing anteriorly to the territory of the proximal portion of the right coronary artery. The sinus node is usually supplied by the sinoatrial branch via the right coronary artery. aortography showed that the right coronary artery ostium was absent. A permanent pacemaker was implanted and the patient was discharged in good condition. The present case suggests that coronary artery anomaly may lead to compromised blood supply to the sinus node, and hence sick sinus syndrome.- - - - - - - - - - ranking = 1keywords = rhythm (Clic here for more details about this article) |
3/73. Case 4: a patient with symptomatic bradycardia.Both the clinical and electrocardiographic presentations of sick sinus syndrome are highly variable. As illustrated by this month's case of Interactive Grand Rounds, the initial challenge to the clinician is to establish the correct diagnosis in the patient who has symptomatic bradyarrhythmias.- - - - - - - - - - ranking = 1keywords = rhythm (Clic here for more details about this article) |
4/73. torsades de pointes ventricular tachycardia induced by mosapride and flecainide in the presence of hypokalemia.We report a 68-year-old man who developed torsades de pointes ventricular tachycardia induced by combined use of mosapride and flecainide. He had a permanent pacemaker (DDD mode) implanted because of sick sinus syndrome (bradytachy syndrome) 6 years earlier. The patient had started taking mosapride for upper abdominal discomfort 2 weeks earlier. On admission, ECG showed prolongation of the QTc interval from 0.48 to 0.56 seconds and self-terminating torsades de pointes occurred. We considered that this proarrhythmia was induced by mosapride in combination with antiarrhythmic agents.- - - - - - - - - - ranking = 2keywords = rhythm (Clic here for more details about this article) |
5/73. Arrhythmias in neurofibromatosis. A case report and review of the literature.patients with neurofibromatosis have a higher incidence of anatomic cardiac abnormalities. However, there is little data regarding incidence of arrhythmias in this population. It is known that these patients have a higher mortality than the normal population, and it is possible that some deaths may be due to preventable causes such as cardiac arrhythmias. We report a patient with neurofibromatosis who was treated for a refractory seizure disorder for 8 years. However, video/EEG monitoring demonstrated that the patient had recurrent syncopal seizures secondary to sinus node dysfunction. Complete resolution of symptoms occurred after a permanent pacemaker implantation. We believe this is the first reported case of sinus node dysfunction associated with neurofibromatosis.- - - - - - - - - - ranking = 6keywords = rhythm (Clic here for more details about this article) |
6/73. Spontaneous regression over a 16-year period of tachyarrhythmias to sick sinus syndrome and complete atrioventricular block in a young patient with Ebstein's anomaly.A 25-year-old man with Ebstein's anomaly showed spontaneous regression of tachyarrhythmias to sick sinus syndrome and complete atrioventricular block over a 16-year period. This is the first clinical report supporting the hypothesis that abnormal cell death might contribute to the disturbance of the heart conduction system in Ebstein's anomaly.- - - - - - - - - - ranking = 5keywords = rhythm (Clic here for more details about this article) |
7/73. Cross-stimulation during lead impedance monitoring.At the age of 4 years, a total cavopulmonary connection was performed in a boy with a complex congenital heart defect. On addition, a DDDR pacemaker was implanted for sick sinus syndrome. Atrial and ventricular leads were epicardially placed at the left atrium and left ventricle. At the age of 10 years, a new epicardial ventricular lead was placed because of malfunction of the existing lead. At the same operation the pulse generator was replaced by a Medtronic Kappa DR 731. After replacement, the boy experienced episodes of phrenic nerve stimulation associated with feelings of discomfort. Holter recordings revealed ventricular stimulation from the atrial stimulus for 2 consecutive beats. This phenomenon repeated exactly every 3 hours and was caused by the automatic lead impedance measurement that used a 5-V, 1-ms stimulus output.- - - - - - - - - - ranking = 2.6995736483361E-5keywords = hour (Clic here for more details about this article) |
8/73. Bundle branch block on alternate beats: by what mechanism?In a patient with right bundle branch block occurring on alternate beats during regular sinus rhythm, the conduction disturbance disappeared during hyperventilation induced increase in heart rate, and reappeared with slight slowing of the sinus rate due to carotid sinus massage. The following mechanisms are potentially involved in the electrogenesis of bundle branch block alternans with regular RR intervals: a) phase-3 2:1 bidirectional block; b) phase-3 antegrade block with retrograde concealed activation of the involved bundle branch and subsequent "supernormal" conduction; and c) phase-4 antegrade block with transseptal retrograde concealed invasion of the affected bundle branch by impulses traversing the unimpaired bundle branch. Analysis of the tracing excluded both mechanisms a and b and favored bradycardia-dependent right bundle branch block as a key to explain the alternate pattern of intraventricular conduction.- - - - - - - - - - ranking = 1keywords = rhythm (Clic here for more details about this article) |
9/73. Cardiac pacing as emergency care for serious bradyarrhythmia with circulatory shock.Three cases of bradyarrhythmia with serious illness of extracardiac organs are reported. Case 1 had sick sinus syndrome. He was admitted to our hospital complaining of syncope and developed apnea. Case 2 had complete atrioventricular block and serious hepatic failure in the hospital. Case 3 had paroxysmal atrioventricular block. He complained of syncope which followed convulsions. Their symptoms might be due to circulatory shock caused by a lazy lower pacemaker from the ventricle. Emergent temporary pacing successfully improved the extracardiac organ dysfunction. Although their bradyarrhythmias were transient, permanent pacemakers were implanted to inhibit the recurrence. A quick temporary pacing should be indicated in patients with critical bradyarrhythmia like our cases for survival.- - - - - - - - - - ranking = 7keywords = rhythm (Clic here for more details about this article) |
10/73. Failure of atrial flutter detection by a pacemaker with a dedicated atrial flutter detection algorithm.Detection of atrial flutter may be difficult for pacemakers with automatic mode switching algorithms. The Medtronic Kappa 700 device pacemakerfamily offers a dedicated Blanked Flutter Search algorithm specifically designed for the detection of atrial flutter. This report describes how spontaneous atrioventricular conduction, resulting in a sensed QRS complex at a critical time, inhibited the function of the Blanked Flutter Search algorithm to sense "concealed" or "blanked" atrialflutter. This observation underscores the need for further refinement of pacemaker algorithms for the detection of atrial tachyarrhythmias.- - - - - - - - - - ranking = 1keywords = rhythm (Clic here for more details about this article) |
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